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General NPI Number Information
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NPI Number | 1679742365
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Entity Type | Organization
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Legal Business Name | JANET WONG AND JENNIFER WONG DENTAL CORPORATION
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 11262 WASHINGTON BLVD
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City | CULVER CITY
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State | CA
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Zip | 90230-4616
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Country | US
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Telephone | 310-390-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 11262 WASHINGTON BLVD
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City | CULVER CITY
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State | CA
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Zip | 90230-4616
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Country | US
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Telephone | 310-390-6500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JANET ELIZABETH WONG
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Credential | D.D.S.
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Telephone | 310-390-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 52131
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 49025
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License Number State | CA
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